Provider Demographics
NPI:1972173060
Name:MUNDY, ANITA H
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:H
Last Name:MUNDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8180 W 4TH AVE APT L206
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7521
Mailing Address - Country:US
Mailing Address - Phone:509-405-4777
Mailing Address - Fax:
Practice Address - Street 1:8180 W 4TH AVE APT L206
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7521
Practice Address - Country:US
Practice Address - Phone:509-405-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00138798163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health